Screening, Assessment, and Diagnostics

Introduction

Individuals with FASD are a subset of individuals
who are affected by in-utero exposure to alcohol.
They are not
necessarily the most severely affected individuals; they are simply
the subset that can be positively identified because of their characteristic
facial appearance (Clarren, S.K., & Astley, S.J. 1993). Other
terms are often used to classify individuals who do not have FASD but
share characteristics associated with FASD (especially central nervous
system dysfunction and other cognitive abnormalities). These terms
include fetal alcohol effects (FAE), static encephalopathy, neurobehavioral
disorder, alcohol-related birth defects (ARBD), and alcohol-related
neurodevelopmental disorder (ARND). These terms are sometimes used
interchangeably. A diagnosis of alcohol-related effects may also be
made with or without confirmed maternal alcohol exposure.

Fetal alcohol syndrome is a medical diagnosis
usually made by a physician specifically trained in the assessment
of birth defects
. Other professionals often assist in identifying
children with known maternal drinking histories or suspected problems.
For example, nurses may be trained to recognize the facial features
of children with fetal alcohol syndrome. It is important that the
physician making the diagnosis is sensitive to the physical characteristics
of the racial group with whom he or she is working because the physical
characteristics of FASD may look slightly different among different
racial groups.

Accurate diagnosis of alcohol-related effects require
that the physician be qualified.
Accurate identification can improve
the child's opportunity to receive appropriate interventions, facilitate
communication among clinicians, caregivers, and educators, and provides
better self-awareness and understanding by family members.

The following information
has been extracted
from Ninth Special Report to the U.S. Congress on Alcohol and Health,
June 1997(RP0973). Free copies of this report are available from National
Clearinghouse for Alcohol and Drug Information, 1-800-729-6686.

A key concern in research and clinical practice
continues to be how best to characterize and identify FASD and other
ARBD arising from prenatal alcohol exposure. Research has shown that
in utero alcohol exposure can produce a spectrum of harmful effects,
ranging from a characteristic pattern of gross morphological anomalies
and mental impairment (including mental retardation) to subtler cognitive
and behavioral dysfunction. FASD is the most severe birth defect produced
by in utero alcohol exposure. The terms "fetal alcohol effects"
(FAE) and "alcohol-related birth defects" are used to describe
individuals who exhibit only some of the attributes of FASD and thus
do not fulfill the diagnostic criteria for the syndrome (Clarren and
Smith 1978; Sokol and Clarren 1989). A medical diagnosis of FASD is
differentiated from a "case definition" for surveillance
purposes.